Pharmacology: CAM Questions With Complete Solutions
Which herbal remedy is described below?
Use: anxiety, depression, fatigue, opioid withdrawal, chronic
pain, sexual performance, to improve mood, enhance physical
endurance
MOA: contains mitragynine, a partial mu-opioid receptor
agonist (about 25% as potent as morphine); opium-like effects;
psychoactive properties
Adverse effects: nausea, vomiting, loss of appetite, loss of
muscle coordination, lethargy/sedation, respiratory depression,
aggression, hallucinations, seizures
FDA warning: kratom use linked to serious adverse effects
including respiratory depression, aggression, seizures, liver
damage, severe withdrawal and death
Pregnancy: Possibly unsafe; neonatal abstinence syndrome seen
in infants of women who used ______ during pregnancy
Effectiveness: Insufficient reliable evidence to rate; Insufficient
information available about the effectiveness for any of the
purported uses
Kratom
Which herbal remedy is described below?
Use: treat liver disorders; cirrhosis & hepatitis; toxic liver
damage caused by chemicals, alcohol and chemotherapy
,MOA: alters livers cells to prevent uptake of toxins, enhances
regeneration of liver cells, antioxidant properties; increases
glutathione
Adverse effects: GI disturbances, laxative effect
No known contraindications or interactions
Pregnancy: Insufficient reliable information available; avoid
using
Effectiveness: Insufficient reliable evidence to rate for cirrhosis,
hepatitis, liver damage caused by toxins/toxicity (conflicting
efficacy); does not significantly affect mortality or LFT’s in
EtOH liver disease; might improve LFT’s in chronic active
hepatitis but does not reduce morbidity/mortality; more
evidence needed to support its use
Milk thistle
Which herbal remedy is described below?
Use: reduce risk of cardiovascular disease, PMS, menopause,
endometriosis
MOA: may reduce inflammation, platelet aggregation and blood
vessel reactivity
Adverse effects: indigestion, nausea, HA
Dosage: 0.6-6 g daily
Use extreme caution in patients with seizures (may cause
seizures or lower the seizure threshold)
,Drug interactions: increased risk of bleeding with anticoagulants
or antiplatelet agents (due to decreased platelet aggregation)
Pregnancy: Possibly safe when used orally and appropriately
Effectiveness: No evidence to support its use for cardiovascular
disease, PMS, menopause or endometriosis
Evening primrose
Which herbal remedy is described below?
Use: conditions of the heart & blood vessels, prevent cancer,
arthritis, bladder infections, DM, prevent/treat COVID-19
MOA: anti-inflammatory effects (inhibit prostaglandins);
inhibiting antigen-stimulated histamine release from mast cells;
antioxidant effects, inhibition of cell proliferation, cell cycle
arrest, etc.
Adverse effects: well tolerated in appropriate doses; HA,
tingling of the extremities
Dose: 250-1000 mg daily for up to 12 weeks
Several drug-drug interactions
Pregnancy: Insufficient reliable information available; avoid
using
Effectiveness: Insufficient reliable evidence to rate for heart &
, blood vessels, prevent cancer, arthritis, bladder infections, DM,
prevent/treat COVID-19
Quercetin
Which herbal remedy is described below?
Use: hyperlipidemia/CVD, improving blood circulation, HTN,
stomach health, DM
MOA: mechanism of lipid lowering not completely determined;
HMG-CoA reductase inhibition (monacolin K chemically
identical to lovastatin)
Adverse effects: limited data; mild HA, GI discomfort u Dose:
1,200 mg PO BID
Several drug-drug interactions (CYP3A4-mediated metabolism)
Pregnancy: Likely unsafe; red yeast constituent, lovastatin, has
induced fetal skeletal malformations in animals; avoid using
Effectiveness: Some clinical research shows certain red yeast
rice products lower total cholesterol, LDL, TG & increase HDL
when used for up to 24 weeks compared to placebo; no data
reported to evaluate its use for improving circulation, HTN,
stomach health or DM
Red yeast rice
Which herbal remedy is described below?
Use: mild-moderate depression, symptoms of menopause
MOA: inhibition of serotonin, norepinephrine and GABA
uptake, may also have dopaminergic activity
Which herbal remedy is described below?
Use: anxiety, depression, fatigue, opioid withdrawal, chronic
pain, sexual performance, to improve mood, enhance physical
endurance
MOA: contains mitragynine, a partial mu-opioid receptor
agonist (about 25% as potent as morphine); opium-like effects;
psychoactive properties
Adverse effects: nausea, vomiting, loss of appetite, loss of
muscle coordination, lethargy/sedation, respiratory depression,
aggression, hallucinations, seizures
FDA warning: kratom use linked to serious adverse effects
including respiratory depression, aggression, seizures, liver
damage, severe withdrawal and death
Pregnancy: Possibly unsafe; neonatal abstinence syndrome seen
in infants of women who used ______ during pregnancy
Effectiveness: Insufficient reliable evidence to rate; Insufficient
information available about the effectiveness for any of the
purported uses
Kratom
Which herbal remedy is described below?
Use: treat liver disorders; cirrhosis & hepatitis; toxic liver
damage caused by chemicals, alcohol and chemotherapy
,MOA: alters livers cells to prevent uptake of toxins, enhances
regeneration of liver cells, antioxidant properties; increases
glutathione
Adverse effects: GI disturbances, laxative effect
No known contraindications or interactions
Pregnancy: Insufficient reliable information available; avoid
using
Effectiveness: Insufficient reliable evidence to rate for cirrhosis,
hepatitis, liver damage caused by toxins/toxicity (conflicting
efficacy); does not significantly affect mortality or LFT’s in
EtOH liver disease; might improve LFT’s in chronic active
hepatitis but does not reduce morbidity/mortality; more
evidence needed to support its use
Milk thistle
Which herbal remedy is described below?
Use: reduce risk of cardiovascular disease, PMS, menopause,
endometriosis
MOA: may reduce inflammation, platelet aggregation and blood
vessel reactivity
Adverse effects: indigestion, nausea, HA
Dosage: 0.6-6 g daily
Use extreme caution in patients with seizures (may cause
seizures or lower the seizure threshold)
,Drug interactions: increased risk of bleeding with anticoagulants
or antiplatelet agents (due to decreased platelet aggregation)
Pregnancy: Possibly safe when used orally and appropriately
Effectiveness: No evidence to support its use for cardiovascular
disease, PMS, menopause or endometriosis
Evening primrose
Which herbal remedy is described below?
Use: conditions of the heart & blood vessels, prevent cancer,
arthritis, bladder infections, DM, prevent/treat COVID-19
MOA: anti-inflammatory effects (inhibit prostaglandins);
inhibiting antigen-stimulated histamine release from mast cells;
antioxidant effects, inhibition of cell proliferation, cell cycle
arrest, etc.
Adverse effects: well tolerated in appropriate doses; HA,
tingling of the extremities
Dose: 250-1000 mg daily for up to 12 weeks
Several drug-drug interactions
Pregnancy: Insufficient reliable information available; avoid
using
Effectiveness: Insufficient reliable evidence to rate for heart &
, blood vessels, prevent cancer, arthritis, bladder infections, DM,
prevent/treat COVID-19
Quercetin
Which herbal remedy is described below?
Use: hyperlipidemia/CVD, improving blood circulation, HTN,
stomach health, DM
MOA: mechanism of lipid lowering not completely determined;
HMG-CoA reductase inhibition (monacolin K chemically
identical to lovastatin)
Adverse effects: limited data; mild HA, GI discomfort u Dose:
1,200 mg PO BID
Several drug-drug interactions (CYP3A4-mediated metabolism)
Pregnancy: Likely unsafe; red yeast constituent, lovastatin, has
induced fetal skeletal malformations in animals; avoid using
Effectiveness: Some clinical research shows certain red yeast
rice products lower total cholesterol, LDL, TG & increase HDL
when used for up to 24 weeks compared to placebo; no data
reported to evaluate its use for improving circulation, HTN,
stomach health or DM
Red yeast rice
Which herbal remedy is described below?
Use: mild-moderate depression, symptoms of menopause
MOA: inhibition of serotonin, norepinephrine and GABA
uptake, may also have dopaminergic activity
